Episode Transcript
[00:00:00] Speaker A: From Riverside Health System. This is the Healthy youy Podcast where we talk about a range of health related topics focused on improving your physical and mental health. We chat with our providers, team members, patients and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health. So let's dive in to learn more about becoming a healthier you.
I am really excited to have with me in the Healthy youy Studio day and would like to welcome to the podcast, Dr. Robert Hale. We are going to unpack everyday health topics and meet the experts guiding our communities to better well being. I'm your host, Frankie Myers.
Today's conversation is about one of the most common serious cancers in the United States, lung cancer, and how radiation therapy offers hope and healing for those facing this diagnosis.
Dr. Hill, I'm really excited to have you with us and thank you for taking time out of your busy schedule to talk with me today.
Dr. Hill is a board certified radiation oncologist who has dedicated his career to helping patients restore both health and quality of life.
Thank you so much again for joining me.
Let's start with the data, what the data shows us. This year, the American Cancer society estimates about 226,000 new cases of lung cancer in the United States alone. It will remain the leading cause of cancer death with more than 124,000 deaths, more than breast cancer, colon and prostate cancer combined.
The good news, death rates from lung cancer continue to decrease in recent decades thanks to fewer people smoking. Yay. Earlier detection. Yay. And better treatments, including radiation therapy. Yay. Dr. Hill, how do these national statistics reflect what you're seeing in your own community? But let's back how did you end up in this line of medicine?
[00:02:05] Speaker B: That's a good question. Well, first, you know, thank you for having me.
[00:02:08] Speaker A: Yes, yes.
[00:02:09] Speaker B: But I'll be honest. So I didn't start out my career in medicine planning to be a cancer doctor.
[00:02:14] Speaker A: Okay.
[00:02:15] Speaker B: About halfway through my 24 year Air Force career, my dad was diagnosed with kidney cancer and it was advanced and the doctors at the time told us that he likely had about six months to live.
At that time, I was just finishing my residency at Johns Hopkins in preventive medicine and public health. And I was about to start a new assignment working for the Air Force Surgeon General at Bolling Air Force Base in the Pentagon. And I remember feeling completely overwhelmed.
His cancer came on suddenly with bleeding and severe pain. And all I could think about was really just how could I find a way to make him comfortable? Yes, I had stopped in to see Dr. Patrick Walsh at Hopkins. He was a well known prostate surgeon there. And he kindly reminded me that this wasn't his area of expertise. He referred me to one of his colleagues, Dr. Michael Carducci.
And I'll never forget how gracious Dr. Carducci was at the time. He validated first of all how scared I felt and said something that really stuck. He said, this is all very scary, but, well, let's take things one step at a time and see what we can do. And he suggested surgery to remove the kidney for symptom relief. And then we'll take a look. So the next morning, I traveled back to Buffalo, where my dad was living, where I'm originally from.
He was hospitalized. I convinced a urologist there to do the surgery, and thankfully my dad did well with it.
After that, Dr. Carducci recommended a couple of medications that had just come out of a clinical trial.
And we didn't know at that time that the clinical trial would be disappointing overall. But for my dad, it actually started making a difference. He had dozens of spots in his lungs where the kidney cancer spread to his lungs, and they actually slowly started to shrink.
So I'll come back to this story later. But the experience of walking through my father's cancer journey opened my eyes to an entirely different side of medicine. So at the age of 35, I made the decision to go back into residency and this time to train in radios oncology.
[00:04:25] Speaker A: Wow.
[00:04:26] Speaker B: So now you asked about the data. So we pick up on your question there because I think this is very important here.
[00:04:32] Speaker A: And I just want to say thank you for your passion and your commitment. It just, I can just feel it and sense it, and it's tied to an extreme purpose related to your father's experience.
It is, yes.
[00:04:47] Speaker B: So those national numbers that you mentioned before really do line up with what we see here in Hampton Roads.
[00:04:52] Speaker A: Okay.
[00:04:53] Speaker B: Lung cancer is still one of the most common cancer diagnoses in our area. Unfortunately, many people are still being diagnosed at a later stage, often stage three or stage four, when symptoms really finally begin appearing.
And it's the symptoms that bring them in to get treatment.
The good news is, though, that's starting to change.
And more people are getting screened with low dose CT scans. We're going to talk a little bit more about that later. And that's helping us catch cancers earlier when they can actually be cured.
It's encouraging to see more early stage cases now than even just a few years ago. So this really is changing. Smoking remains the biggest risk factor, but we're seeing steady Improvement there, too.
Smoking rates in the Hampton Roads overall have been dropping, especially among men.
But what's interesting, though, is the gap between men and women has narrowed and more women are being diagnosed now and sometimes with far less smoking exposure, which is interesting. And that really reminds us that there are other factors like secondhand smoking, radon gas, even genetics. These all can play a role as well.
[00:05:58] Speaker A: Yes.
[00:05:59] Speaker B: On the treatment side, the advances have been tremendous. We now have very precise radiation options like stereotactic body radiosurgery. Sbrt, as we call it, can treat small tumors in just a few sessions, often with excellent control, minimal side effects.
For patients with more advanced disease, we have immunotherapy targeted drugs that have completely changed the outlook for these patients.
Patients who might have only lived a few months a decade ago are seeing now living years, which is incredible, and they're living well on top of that. And so while lung cancer still is a major health challenge, certainly in our community, we're definitely moving, we're moving in the right direction. There's no question. So fewer people are smoking, more cancers are being caught early. Our treatments are better than ever. And that combination is really making a difference for patients and families right here in the Hampton Roads.
[00:06:54] Speaker A: Absolutely. That's great news and great information.
All right. When we talk about lung cancer risk, smoking often comes to mind. But what else plays a role?
[00:07:07] Speaker B: Yeah, that's a great question. So, I mean, you're absolutely right. Smoking is still the biggest risk factor for lung cancer, but it's by far the only one. Right.
We think of lung cancer risks in two main categories. There are things that we can't change and things that we can change. So on the things that we can change size, we call these the non modifiable risk factors.
And of course, age is a big one. We can't change our age. Right. The risk of lung cancer goes up as we get older. The risk of any cancer goes up as we get older.
Genetics and family history play a role. You can't really change those, can you? And some people may inherit a tendency that makes their lungs more vulnerable to developing cancer, even if they've never smoked again, these are non modifiable risk factors. Now, on the things that we can control, the modifiable side, smoking, of course, is the primary driver.
No question about that. The secondhand smoke exposure still causes a significant number of lung cancers each year.
We also see risks from environmental and occupational exposures. There's things like radon gas, which may, you may be exposed to in the home, not necessarily occupational exposure as Best as diesel exhaust and long term air pollution.
There's a few other contributors that we don't always think about. So prior chest radiation, for example, chronic lung diseases like copd, both of which can increased risk over time.
And then there's newer areas of concern. So for instance, smoking marijuana, especially when it's inhaled deeply without filters, that may raise lung cancer risk. Although the research for this is still is still developing.
With vaping, we know that it can damage the lungs, but we're still studying exactly how it affects long term cancer risk. And finally, there are some differences between race and ethnicity, Race and ethnicity that are important to recognize.
Black men are about 12% more likely to develop lung cancer than white men. But interestingly, they're somewhat less likely to develop small cell lung cancer, which we don't completely understand why, while smoking remains the main driver, it's really a combination of factors. Age, environment, genetics, lifestyle, even where you live, that all contributes to lung cancer risk. So I think the key takeaway is that awareness and prevention really still make a big difference.
[00:09:27] Speaker A: Yes, that was my next question. What role does patient awareness play?
So I don't know if you want to add anything.
[00:09:34] Speaker B: Plays a big role.
[00:09:34] Speaker A: I think you covered it.
[00:09:36] Speaker B: Honestly, it can make all the difference between finding lung cancer early or finding it too late. That's really what it comes down to. Because one of the biggest challenges with lung cancer is that early symptoms can be subtle and that people often brush them off as something minor. Right. Like allergies, a lingering cold, or just getting older. Right. But it's so important to pay attention to changes in your body.
Some of the warning signs we worry about can include a cough that doesn't go away or gets worse over time, or coughing up blood or chest pain that's persistent or sharp when you breathe in deeply, shortness of breath, even unexplained weight loss.
So if you notice any of these symptoms, don't ignore them. Don't wait months hoping that they're going to pass. Because early evaluation really matters. And the sooner we can detect a problem, the better the chance for effective treatment and cure. And while lung cancer is more common in older adults, it's also important to remember it's not just a disease of older people. Unfortunately, we see it in younger people too, even those with minimal smoking history. So if something feels off, if your breathing changes or that cough just won't go away, reach out to your primary care provider and get it checked. Awareness in action. These are two things together that can save lives in lung cancer.
[00:10:46] Speaker A: Absolutely. Great information.
Early detection is key and screening is one of the best tools we have.
But many people are not sure if they qualify. What is the recommendation?
[00:10:58] Speaker B: Glad you brought it up. That's an important question because screening is really one of the most powerful tools that we have for saving lives for lung cancer, there's no question about that. Here at Riverside, we follow national guidelines and recommend what's called an annual low dose CT scan. We abbreviate it. Ldct, low dose CT scan for adults between the ages of 50 and 80 who have had a 20 pack year smoking history. So that means you've smoked the equivalent of a pack a day for 20 years. That's a 20 pack your smoking history and who either still smoke or who have quit within the past 15 years. Those are the criteria for the low dose CT scan.
[00:11:35] Speaker A: Okay.
[00:11:35] Speaker B: So this screening, it's been proven to find lung cancers at much earlier stages when they're small and then it's easier to treat. And it's, and they're curable when they're small. And the scan itself is quick, it's painless and uses a tiny amount of radiation. And it's important to remember it's your primary care provider who orders the screening. So that's the best place to start if you think you might qualify. Talk to your doctor about whether the low dose CT is right for you. Even if you feel completely fine, don't wait to be screened. Right. The best time to catch the lung cancer is before you have any symptoms. That's when the treatment works best and survival rates are the highest.
So if you're between that 50 to 80 range with a smoking history, reach out to your primary care provider and get the referral. It's one simple step. It could truly save your life.
[00:12:25] Speaker A: Absolutely. You heard it here. Great information.
Now let's talk about treatment. When people hear radiation, it can sound scary.
Can you explain what it really means?
[00:12:35] Speaker B: So, yes.
So screening is absolutely critical because the reality is lung cancer doesn't cause any symptoms until it's really advanced. Unfortunately, a lot of cancers don't. But by the time someone starts noticing a cough or chest pain, shortness of breath, this cancer probably already spread.
And that's what makes screening so powerful.
But it lets us find the disease before the symptoms appear.
The screening we use, this ldct, the low dose ct, it's quick, completely painless, uses a very small amount of radiation. We find these little spots are called nodules. Now, not all nodules are going to be cancer.
Sometimes we'll follow these to See if they're growing.
Catching these early then will give us the best chance of a cure if in fact they turn out to be cancerous.
When a lung cancer is found early, what we call a stage one or stage one a is the earliest form of lung cancer. The five year survival rate is over 90%. Pretty high if we wait till stage four. And this means where the cancer is spread to other parts of the body, the survival drops low. It's less than 10%, it's not zero, but it's low.
So finding it early can really truly be life saving. And studies showed that this have shown repeatedly that the strategy of low dose CT scanning to catch lung cancer early reduced deaths. So again, even if you feel fine, get the CT scan, it can really make a difference.
[00:14:02] Speaker A: Okay, very good.
What role does radiation play specifically in lung cancer?
Alongside the benefits of treatment, can there also be side effects? And what might patients experience? It's kind of a twofold question.
[00:14:20] Speaker B: So radiation is one of the main tools that we have in treating lung cancer, but its role really depends on the situation. So I like it. I think about breaking it down into two buckets.
There's one where we're trying to cure the cancer and the other when we're trying to relieve symptoms.
Let's talk about first the curative role. If someone has early stage lung cancer but can't have surgery, let's say a 70ish year old male with a small tumor maybe has poor lung function, radiation in that situation could be used to cure the cancer. We use very precise technique called sbrt, stereotactic body radiotherapy.
It delivers just very high doses of radiation very precisely. We have excellent long term control with it.
Now take a patient that has more advanced disease still localized in the chest.
Instead of using sbrt, we would use radiation combined with chemotherapy in that situation.
And these days now, it's often followed on by immunotherapy. And it's been the immunotherapy actually that's made the huge difference in survival. We've always been pretty good at being able to kill the tumor where it started in this chest. The frustrating part would be as we get the tumor in the chest under control and it would go on to spread. And this is where immunotherapy has really made a difference.
Now the other side of the coin is the palliative care. If the cancer's already spread, then radiation usually isn't curative. There are times that we treat a patient with palliative intent and it winds up being curative. But that's not really the intent or what we're expecting, certainly, but it's still incredibly valuable for quality of life. So imagine a patient with a tumor blocking an airway where it's, you know, difficult to breathe. We can use radiation to shrink the tumor and to improve those symptoms. Even if we don't change their life expectancy, we've improved their quality of life, which I think is very important.
So the most important thing, I think, is that cancer treatment now is very personalized. And this is really the new thing, is that the stage of the cancer matters, but also where the tumor is located matters. The shape of the tumor.
A small tumor out in the periphery of the lung can have very focused treatment, but something more centrally requires a more sort of combined approach with chemotherapy. We stretch out the radiation longer because we can't get big doses all up at once. So this concept of personalized medicine, I think, is very important, where no two cancers are really the same.
[00:16:48] Speaker A: Absolutely. Absolutely. Great information. I'm going to jump down to this next question.
How do you support patients emotionally through this journey?
[00:16:59] Speaker B: Yeah, that's also a great question, too, because it's not just about the cancer treatment. Right, right. It's a whole person that is going through this. And one of the biggest supports we have are what we think with care navigators. So there are actually lung cancer care navigators very important to walking the patients through these steps, answering questions, coordinating their appointments, just being a steady point of contact through the journey.
We also put a strong emphasis on emotional wellness, and that might mean connecting patients with social workers or counselors or support groups, even where they can talk with one another.
Patients are going through similar experiences, can share their experiences. I guess misery loves company, but also an awareness from the provider side that just like Dr. Carducci had those very comforting words for me, just validating that I was going through a terror moment.
And when you do that, it just helps to let the patient understand that they're not in this alone and that what you're feeling is valid. And I think that's very important.
[00:18:06] Speaker A: And you remember that today.
[00:18:08] Speaker B: Yeah, I will always remember that.
And let's not forget about bringing family and caregivers into the fold to, because that could be a very important support system. Oftentimes. Not always, but oftentimes. And so we like to have the loved ones included in the journey as well.
[00:18:24] Speaker A: Absolutely. Absolutely.
Let's look to the future. How has radiation oncology evolved and what's ahead for patients?
[00:18:32] Speaker B: Oh, my gosh. It's really come a long way Especially in lung cancer as we're talking about today. So a generation ago, treatments were less precise, they carried a lot more side effects. We really didn't know what we were treating on a day to day basis. We, because we couldn't see what we were treating like we can now.
Today we're able to deliver these treatments with millimeter accuracy, which is incredible.
We can shape the dose to the tumor, we can protect the healthy tissue. In doing so, it means better control of the cancer and fewer side effects for the patient.
The future of lung cancer goes well beyond the radiation alone. Right. So for instance, the lung nodule clinic. Diagnosing the cancer earlier really shifts how we're able to approach lung cancer treatment, which is not just about the treatment, but about picking up these cancers earlier. That's been an important change.
[00:19:21] Speaker A: Absolutely.
[00:19:22] Speaker B: We talked about the modifiable risk factors. Right. So an awareness about the things that you can do to change the risk of getting a cancer.
Recognizing a cancer when it's early technology, such as the robotic navigational bronchoscopy. So this is a technology where the pulmonologist can go in with a guided bronchoscopy and find the spot that may be a cancer and biopsy it. Because one of the biggest challenges has been we can see a nodule in the middle of the chest, but you can't get to it easily. And if you biopsy it and you miss it, it comes back normal lung tissue. It hasn't really told you anything.
So it's kind of a swing and a miss. And then the care doesn't stop where the treatment ends because there are ongoing considerations. We call this survivorship care. After you've finished your treatment, there are things to watch for, to make sure that the cancer is in fact under control and also that we're taking care of the things that can go awry because of treatment and address those concerns early.
So I think it's about precision and early detection and integration with new technologies and whole patient support. Those are the essential elements.
[00:20:28] Speaker A: Yes. Great, great, great information.
Finally, let's leave our listeners with the top three actions someone can take today and your message to anyone feeling afraid.
[00:20:40] Speaker B: Yeah.
So I love, I love wrapping it up that way with kind of a, kind of a toolkit here. So let's, let's talk concretely here. So first, if you're at high risk for lung cancer, so maybe you're current or former smoker or you've had significant exposure to, you know, asbestos or radon in the home, so get screened with the low dose CT scan. Second, know the signs and symptoms of the lung cancer. Right.
So things like the persistent cough, the chest pain, unexplained weight loss, coughing up blood. If you notice something that doesn't feel right, get it checked out early. And the third thing is, quit smoking might be the most important thing. And it's never too late to quit smoking. Right. It may feel like it's overwhelming to do that, but there are medications and counseling and support programs. There are things that can really help.
And as a bonus, let's add on the healthy habits. Right? Yes. So the regular exercise, the balanced diet, the, you know, cutting down the things that induce inflammation and protecting yourself from the environmental exposure, Right?
[00:21:43] Speaker A: Absolutely.
[00:21:43] Speaker B: So I think that would be the. The toolkit that I will give you.
[00:21:46] Speaker A: Yes. I love that.
What about someone feeling afraid?
[00:21:52] Speaker B: Well, so at the beginning, I started the conversation talking about my dad's experience.
And what I didn't share with you at the beginning is how that story actually ends.
So after his surgery, he went on to receive what we think of now as a very primitive form of immunotherapy therapy that essentially teaches the body how to fight the cancer, the body's immune system.
And it was very primitive. And remember, in that clinical trial, it was shown actually not to work. But amazingly, he responded.
And over time, most of the tumors in his lungs actually disappeared.
A couple years later, we were down to a couple of spots, tiny spots. He had to come off the medication because he was irritating his liver, and a new spot formed, and he was able to have them treated with this treatment we've referred to before, this sbrt, the stereotactic body radiosurgery, using these very finely focused beams of radiation.
At that time, it was still considered experimental. In fact, there were some doctors in his care team that recommended he didn't do it.
[00:22:54] Speaker A: Right.
[00:22:55] Speaker B: But here's the remarkable part, is that it worked. Right. And he's now 87 years old. He's alive, and he's cancer free.
[00:23:03] Speaker A: Wow.
[00:23:03] Speaker B: Yeah.
[00:23:04] Speaker A: That's awesome.
[00:23:04] Speaker B: So his journey didn't just change the course of my career. Right. It. It was a constant. It is a constant reminder to me that cancer care is more than just treating the disease. Right. It's about restoring hope, dignity, and quality of life.
And so if you're listening and you're feeling afraid, remember that knowledge is power and that modern cancer care, including radiation therapy, offers more options than ever.
There is real hope. And most importantly, you are not alone in this journey. I think that's very important to remember.
[00:23:42] Speaker A: Yes. Absolutely. Our patients and community are so fortunate to have you.
Thank you. Thank you so much for what you do.
Again, Dr. Hill, thank you for shining the light on cancer care and how radiation therapy restores life and hope.
This conversation truly can save lives. And that's our intent today to our listeners. If this episode helped you or got you to think differently about your health, or reminded you to ask your provider about screening, share it with a loved one.
Visit Riverside website for more expert guidance and patient stories. Until next time, stay healthy. Thank you, thank you.
Thank you for listening to this episode of Healthy Youth. We're so glad you were able to join us today and learn more about this topic. If you would like to explore more, go to riversideonline.com.
